"It looks like there are large holes in the brain and it's just not true. It's based on faulty data... something went very wrong in [Ricaurte's] brain scan study and I and many other scientists would draw no conclusions from his study because his study was just too flawed."

We are rarely surprised by media coverage about recreational psychoactives. Most can be lumped into the broad genre of sensationalist exposé about the terrible dangers of drugs designed to titillate teens and frighten parents. The ABC News special "Ecstasy Rising", first aired on April 1st, 2004, stands out mostly because of the very high contrast with the typical news stories about the illegal use of psychoactives. It also stands out because it represents a real effort to document some of the serious failings in the government's 'war on ecstasy' and some of the collateral damage that it has caused.

The main messages of Ecstasy Rising can be summarized as: Ecstasy has become the second most popular illegal psychoactive drug for new users, its use has grown at an unprecedented rate, there are many seemingly sane people who believe it can be beneficial, the government has radically overstated the health risks in order to try to stop young people from trying it, the "holes in the brain" research was just wrong, and the exaggeration of the risks alone may have cost our society more than we know.

The hour-long special clearly represented an effort by Peter Jennings (both narrator and executive producer) and the ABC News team to do new investigative reporting. They had been working on this show for well over a year before it aired. Erowid first heard about the story in late 2002 when we were contacted by ABC about an interview (we declined to participate). They included historical footage, images, and interviews of interest even to those who spend all their time following this field. The most novel elements were clips from the infamous 1985 Donahue show about Ecstasy, photos of Leo Zeff, an influential underground therapist in the 1970s who advocated the use of MDMA as an adjunct to psychotherapy, and an interview with Michael Clegg, the person believed to have coined the term "ecstasy" who was key to popularizing MDMA in Dallas in the early 1980s.

The show, overall, was excellent. Ecstasy Rising should be considered required viewing for anyone interested in ecstasy-related media. By far the weakest part of the show was how the producers chose to balance the issue of health risks. Most of the narrative thrust of Ecstasy Rising was to point out problems with the mainstream, government-produced information about MDMA, so their choices are understandable. But it seems very clear that the message most viewers might take away is that ecstasy has few, if any, serious health risks associated with its use. (No clear distinction was made in the program between "ecstasy" as an unregulated street drug of varying composition and pure MDMA.) We were very surprised that our editorial standards for presenting medical risks are more conservative than those used by the producers of Ecstasy Rising.

ABC News one-hour documentary about ecstasy covering history of its popular use in the United States. Program included coverage of therapeutic use, scheduling, rave use, controversy around brain damage research, and the difficulty the government has had in stopping the spread of its use.

One of the most data-oriented shows about ecstasy ever on television, actual investigative journalism.

Strongly presented the arguments countering the claim that MDMA is an extremely dangerous, brain-damaging drug.

Included elements that were surprisingly positive about MDMA, much more so than any mainstream news we can recall.

Extremely damaging to Ricaurte's credibility and the validity of his research.

"I've never heard people say to me 'methamphetamine improved my life, I'm a better person for having used methamphetamine'. Same thing with cocaine. I know people who like to use cocaine, but I've never heard anybody try to claim 'cocaine is good for me'. MDMA, lots of people think the drug improved their life, and continued to think that after they stopped using it."

One of several things that really stood out about Ecstasy Rising is that the producers chose to give voice to a wide variety of people who spoke positively about MDMA, and seemed to be very intentional about having speakers of many different ages. Normal coverage of ecstasy "news" focuses heavily on current youth users, who tend to appear less articulate and less sympathetic witnesses to parents and middle-aged adults. Mainstream news most often shows sober, adult, health and law enforcement professionals saying ecstasy is bad against a backdrop of reckless, poorly informed youth users and clips of sweaty raves. Ecstasy Rising showed clips of a dozen or so people who spoke positively of their experiences. Most of these were middle-aged or older, and many were speaking in glowing terms about their long-past use.

The depiction of middle-class, intelligent adults who are happy they had used ecstasy and believe it was, on balance, positive for them threatens the prohibitionist-projected image of teens recklessly drugging themselves and regretting their mistake later in life.

Foremost in our minds as we watched the show was "How is Middle America reacting to this?" What a strange experience it must have been for many people who were expecting to tune into another dramatic retelling of how a seductive "new" street drug causes permanent brain damage and leads innocent, healthy youth into a criminal life of misery and regret. Instead, they found a number of calm, well spoken 40- to 85-year-old people saying that MDMA had changed their lives for the better. The always humble, grandfatherly Myron Stolaroff's wonderful "I highly recommend it!" followed by a chuckle must have been quite a shocker. After the show, we went and read the viewer response section of the ABCNews.com website and found a huge number of posts. Disgruntled parents who said they had to send their kids away during the show because it was too positive said they had asked their kids to watch the show to deter them from using ecstasy and then had to tell them to stop watching because it did not demonize the chemical enough. Most of the posts to the website were strongly supportive of the show, however.

Although Ecstasy Rising quoted MDMA proponents saying very positive things about it, the story did not portray them as deluded, damaged, or insane. The quotes they chose were surprisingly level-headed and moderate. Even the quotes by Michael Clegg, self-described as one of the largest ecstasy dealers and evangelists in the early 1980s, said: "I would like to have seen some control on it, through a doctor's prescription, through a psychologist, that's something I would like to have seen. But just to say no one can ever take this again, ever ever under any circumstances, that's sad when you believe in it so much."

Quite often, news stories will include quotes from prohibitionist administrators, law makers, or DEA agents that highlight extremely puritanical or prudish views. It often seems they are not just fighting a Drug War, but a culture war. In Ecstasy Rising Gene Haislip, a former DEA Deputy Assistant Administrator from 1980-1997, is quoted describing disdainfully what ecstasy users report: "This whole thing is pitched as a self development type of experience, get in touch with nature, get in touch with the universe, get in touch with your mother: get in touch with everybody. It's a touchy feely type of experience that they describe, well, because of course this has appeal, this is clever advertising."

Mr. Haislip was on the panel of a 1985 Donahue talk show devoted to ecstasy. Among the best historical footage included in Ecstasy Rising, that particular Donahue show is infamous because it was part of the first mainstream coverage of ecstasy use in the early 1980s. In a very striking exchange, a woman in the audience admits to doing ecstasy. She appears to be in her 40s, is diagnosed with terminal cancer, and explains that the diagnosis had lead to her closing down emotionally. She describes how much ecstasy had helped her. "[Ecstasy] has allowed me to open up and have communication with my family that I've never been able to have before." When Phil Donahue asks her "How often do you take it?" she answers "I've only taken it once."

The condescending "touchy feely marketing" quote by Haislip was juxtaposed with the story of the woman with terminal cancer and another woman who had been "raped and tortured" who found MDMA-facilitated psychotherapy benefitted her recovery and made it possible for her to function as a mother again.

A strange counterpoint to any prime time story about drugs in 2004 is that a large portion of the advertisements are pharmaceutical ads, often for psychoactive medications or sex drugs (Viagra, Cialis, etc.). A particularly striking advertisement currently playing, which happened to run during Ecstasy Rising, is an American Association for Retired Persons (an advocacy group for older people) commercial that shows apparent War on Drugs news clips and then discusses AARP efforts to secure taxpayer funding for prescription drugs. The commercial ends with "This is a drug war we can win."

One of the clearest losers in this story was Dr. George Ricaurte, who has had a really bad year. At the top of the NIDA-funded heap for ecstasy brain damage research until last year, he suffered a huge loss when it was discovered that his 2002 "single dose of ecstasy causes Parkinson's" paper [Abstract] was invalid because his lab gave methamphetamine to the primates instead of MDMA. Since the disclosure of this failure in fall 2003, Ricaurte and his lab have been criticized by dozens of newspapers and many of his previous findings have come under harsher scrutiny. The Peter Jennings special not only mentioned this failure, but also used a large segment to cover criticisms of past work from the Ricaurte lab.

After illustrating scientific problems with his work and making it clear that the expert scientific community no longer considers his early brain-damage scans valid, they showed stock footage of Ricaurte and said that he declined to comment or participate in the program. Evidence mounted through the show that the "holes in the brain" meme the government has been pushing for the last five years was based on faulty science and political motives. It seemed as if Ecstasy Rising signaled the beginning of the end of the ecstasy "holes in the brain" scare story.

Alan Leshner, former director of NIDA, was repeatedly shown stating that ecstasy is "not a benign fun drug", but by the placement of his clips the producers were clearly suggesting he was in error. Over and over again, government officials talking about dangers were presented as being factually wrong. A DEA agent was filmed saying "for lack of a better term, it turns your brain into Swiss cheese... puts holes in it, does permanent brain damage, irreversible, irreversible from the very first time. So the great fear is that we could have a generation of people who have used this drug who appear to be stroke victims and can't even care for themselves by the time they reach their 40th or 50th birthday." But then the story goes on directly to talk about how the huge government anti-ecstasy campaign showing "holes in the brain" was based on faulty evidence.

"The propaganda effort has had its impact, but it competes poorly with word of mouth. Especially when there are older users who say 'No, not as far as I can tell.'"

-- Dr. Mark Kleiman

The science of the issue was repeatedly summarized as "the jury is still out", a quote that was also shown on-screen from a New Scientist review of the evidence for brain damage, and read by Peter Jennings [Commentary]. Jennings interviewed Stephen Kish, a brain-imaging expert who became involved in the ecstasy debate two years ago when he published a review of the Ricaurte lab PET scan data. Jennings described Kish as "especially critical of the NIDA postcard and the science behind it".

Kish said "It looks like there are large holes in the brain and it's just not true. It's based on faulty data... something went very wrong in his brain scan study and I and many other scientists would draw no conclusions from his study because his study was just too flawed."

Ecstasy Rising strongly suggested that newer research appears to be much more reliable. Jennings described the far more rigorous study published in 2003 by Buchert et al. of Hamburg, Germany which, Jennings says, "found only a slight, 5% loss of serotonin function" that "may be reversible". According to Mark Laruelle of the NY State Psychiatric Institute, a "leading brain imaging expert" referring to the Buchert study, "in people who had used ecstasy, but who had stopped taking ecstasy for two or three months, normal serotonin function was found. There was indeed a reduced serotonin function but that reduction may be reversible after 2-3 months of abstinence."

Peter Jennings summarized the problem: "The U.S. government's claim that ecstasy causes devastating, irreversible brain damage was a dramatic exaggeration of the risk."

The message of the failure of propaganda and the damage that such exaggeration may have caused was repeated again and again. Rick Doblin, Ph.D. summarized it as "Young people don't believe, many of them, that ecstasy causes holes in the brain, or that it will profoundly inhibit your ability to be a student or reduce your capacity for emotional expression because they don't see that directly. I think that kind of exaggeration of risk is harmful in and of itself, more so even than the drugs, because it causes people to believe nothing they are told."

The show then cuts to a short series of ecstasy users supporting that point, saying in one example: "They are going to lie about everything."

Ecstasy Rising repeatedly intercuts public policy expert Mark Kleiman, Ph.D. as a sober, concerned voice of reason. He puts the issue in some historical context and suggests a view of the issue which goes well beyond the Drug War: "There is a very, very heavy cost to the process of devaluing information that comes from the government. Lincoln was right. Government trust is a precious resource and there's a question about how much of it we want to squander in telling kids not to use drugs."

Jennings again comes back to the point that even with the massive propaganda effort and enforcement costs, ecstasy use has increased at an unprecedented rate: "It is a nightmare of their own making: the government has been determined to stop the spread of ecstasy by making dramatic claims about brain damage that are exaggerated and unconvincing. Ecstasy users are just not listening. Point-eight million Americans will try ecstasy for the first time this year."

The worst part of the show from our perspective was certainly the way they handled the sensitive issue of health risks. Because the emphasis was on exposing errors in the conventional information about ecstasy, they focused too much on brain damage and the risk of death, which are the main points of anti-ecstasy propaganda, but which are both mostly red herrings.

"The risk of sudden death is miniscule, overstating this risk is not going to stop them from taking the drug."

-- Peter Jennings

Jennings asked Glen Hanson, interim director of NIDA from 2001-2003: "Do you believe that pure ecstasy can cause people to die?" Hanson replied, "I think there are some individuals who are especially vulnerable to this drug and it will kill them. Are there a lot? I don't believe there are a lot."

The story then talked to James Gill, a forensic scientist from New York City who had looked at coroner's office data for New York. Gill describes a period during which there were 19,000 deaths where only 22 of the deceased were found to have ecstasy in their system and only "two of those died from ecstasy and ecstasy only". Jennings reiterates the point: "Two deaths, during a period according to the DEA, that New Yorkers used about 110 million doses of ecstasy." And, finally, Jennings states: "The risk of sudden death is miniscule, overstating this risk is not going to stop them from taking the drug."

Although the show was working to balance the vast amount of hysterical (and often just wrong) information about the dangers of ecstasy, the overall impact of the show was to downplay the medical risks more than we feel is appropriate.

Although everyone can agree that the risk of death for an informed person taking an appropriate dose of pure MDMA in a controlled setting is extremely low, the use of the word "miniscule" can only be seen as a "green-light" word for the less informed. We were a little taken aback that ABC News's editors would have let this through, since they did not discuss the far more common hospitalizations and problems associated with street ecstasy use. This was the main criticism we had of the show.

Yes, the risk of death is small, but the show chose to focus on the false dangers of ecstasy (brain damage and Parkinsonism) and the only real practical issue they spent any time on, they called "miniscule". By virtue of the combination of these two, the show created the impression that there are no serious health risks associated with ecstasy. They would have done better to include the voice of emergency medical personnel who work at large commercial events.

Taking more than one "E" pill from an unknown source in harsh environments makes the risks far greater. The main message needs to be that one can control the risks to which one is exposed and not "the risks are too small to think about".

Perhaps the most negative things that Ecstasy Rising included about ecstasy use were very short quotes from a few users at the end of the segment who seemed to be describing how ecstasy had negatively impacted their lives. After an introductory "...but a small number of users do say they have become deeply dependent on the drug" they included sound bites like "It's not worth the after-effects", "It's addicting", and "When I am on ecstasy, I think 'oh my god, I love this feeling' and I never want it to leave me, so you just start taking more pills." But the overall message was clearly restated by Jennings: "The bottom line for many users is that ecstasy is not heroin and it is not cocaine or crack cocaine and many people believe that ecstasy (MDMA) is powerfully beneficial."

Ecstasy Rising quickly returned to its strengths and made the important point that the dangers of ecstasy increased after it became scheduled.

The report tries to suggest that ecstasy presents unique issues that differentiate it from other street drugs. "The facts about ecstasy use are astonishing. According to the DEA, hundreds of millions of ecstasy pills are taken by Americans every year... No other drug has ever spread so fast," Jennings narrated. Ecstasy Rising made the point that MDMA may be different than other vilified drugs because so many people report positive experiences from using the substance.
Mark Kleiman highlighted this point: "This drug may be one of the hardest drugs to effectively prohibit, because it seems to create lots of satisfied customers and a relatively small number of unhappy customers. A drug like that is likely to spread far and wide."

Dr. Kleiman continued describing why MDMA is a different type of problem than methamphetamine and cocaine: "I've never heard people say to me 'methamphetamine improved my life, I'm a better person for having used methamphetamine'. Same thing with cocaine. I know people who like to use cocaine, but I've never heard anybody try to claim 'cocaine is good for me'. MDMA, lots of people think the drug improved their life, and continued to think that after they stopped using it."

The show ended by reiterating the Boy Who Cried Wolf theme: "Recent studies may be reassuring to users, but no one can rule out the possibility the government will one day discover that MDMA (ecstasy) does in fact cause long term brain damage. The question then -- will anyone believe them?"